[Cracovian clinical toxicologists international activity in last 50 years].

We present 50 years of scientific activity Depertment of Toxicology Jagiellonian University Medical Collage in Krakow on national and international arena. Scientific achievements are presented divided into thematic groups. The subject group covers a broad spectrum of research taking into account the epidemiology of poisoning, occupational and population exposure to chemical substances, specific toxicological problems like; diagnosis of poisoning, predicting the severity of poisoning, the implementation of appropriate treatment depending on the phase of intoxication and its severity, effectiveness evaluation diagnostic and treatment procedures, prevention and prophylaxis of poisoning.

[Vitamin K antagonists overdose]. / Przedawkowanie antagonistów witaminy K.

Nowadays, anticoagulant therapy belongs to the most commonly used forms of pharmacotherapy in modern medicine. The most important representatives of anticoagulants are heparins (unfractionated heparin and low-molecular-weight heparin) and coumarin derivatives (vitamin K antagonists--VKA). Next to the many advantages of traditional oral anticoagulants may also have disadvantages. In Poland most often used two VKA: acenocoumarol and warfarin. The aim of the work is the analysis of the causes of the occurrence of bleeding disorders and symptoms of overdose VKA in patients to be hospitalized. In the years 2012 to 2014 were hospitalized 62 patients with overdose VKA (40 women and 22 men). The average age of patients was 75.3 years) and clotting disturbances and/or bleeding. At the time of the admission in all patients a significant increase in the value of the INR was stated, in 22 patients INR result was " no clot detected", on the remaining value of the INR were in the range of 7 to 13.1. On 51 patients observed different severe symptoms of bleeding (hematuria, bleeding from mucous membranes of the nose or gums ecchymoses on the extremities, bleeding from the gastrointestinal tract--as in 5 patients has led to significant anemia and transfusion of concentrated red blood cells. Up on 33 patients kidney function disorder were found--exacerbated chronic renal failure and urinary tract infection. 8 diagnosed inflammatory changes in the airways. On 13 patients, it was found a significant degree of neuropsychiatric disorders (dementia, cognitive impairment), which made impossible the understanding the sense of treatment and cooperation with the patient. In 6 patients the symptoms of overdose were probably dependent on the interaction with the congestants at the same time (change the preparation of anticoagulant, NSAIDs, antibiotics). In 2 cases, the overdose was a suicide attempt in nature. In addition to the above mentioned disorders, on two of those patients diagnosed with a malignant disease. Two patients died, the other has been improving and anticoagulant therapy with VKA was continued, in 4 VKA were changed to low-molecular-weight heparin, and on 4 commissioned new generation anticoagulant (rivaroxaban).

[Acute poisoning with levothyroxine in own experience]. / Ostre zatrucia lewotyroksyna w materiale wlasnym.

Exposure to thyroid products is common, but acute poisonings in adults are rare. Most cases of severe toxicity are related to prolonged, repeated exposure (either inadvertent or deliberate abuse). There are a few reports of toxicity in children following large (greater than 10 mg) single ingestions. Expect significant toxicity in children and adults who have ingested more than 2 to 4 mg of levothyroxine. However, in comorbid elderly patients, the threshold may be lower. In this paper we present acute overdose of levothyroxine in nine adult patients (aged 21-44 years; mean--30.5 years); ingested doses were from 1.2 mg to 15 mg (mean--6.5 mg). Only in three cases (ingested doses were 5.6; 8.0 and 15 mg) minor and mild clinical symptoms were observed and pharmacological treatment was necessary. No severe symptoms were observed in our group. Asymptomatic clinical course in patients who ingested more than 3 mg of levothyroxine probably was related to coingestion of benzodiazepins, beta-blockers, ACE inhibitors and ethanol. Serum free triiodothyronine (T3) level of 20 pg/ml (normal, 4.1 pg/ml) was reported following an overdose of 15 mg levothyroxine in day five. Normalization was observed in day eleven.

Abnormal glucose metabolism in men with alcohol withdrawal syndrome.

UNLABELLED: The aim of the study was to evaluate the glucose metabolism in patients suffering from ethanol withdrawal syndrome. The study group comprised 88 alcohol dependent men aged 21- 50 y (mean 39.18 years, SD ±7.78), treated at the Clinical Toxicology Ward. Alcohol dependence was diagnosed accord- ing to the criteria of the International Statistical Classification of Diseases and Related Human Problems (ICD-10). The degree of alcohol withdrawal syndrome was assessed according to the scale CIWA-Ar. The blood ethanol concentration, and glucose serum concen- tration were measured on admission. On the next post-admission day blood glucose were determined after fasting and at the 0, 60th and 120th minute of an oral glucose tolerance test (OGTT) using 75 g glucose. Basing on the recommendations of Polish Diabetes Association (2013y) the patients were classified into one of groups according to their glucose tolerance test results. RESULTS: Mean duration of alcohol dependence was 10.56 years ± 7.78. A mean CIWA-Ar scale score was 23.95 points ± 2.81. Mean BMI was 24.65 ±3.74, overweight and obesity were determined in 35.22% examined men. Normal glucose tolerance were found in 54.55%, abnormal fasting glucose and/or abnormal glucose tolerance were noted in 23.87%, diabetes in 10.23%, and hypoglycemia in 11.36% of examined patients. Intensity of withdrawal syndrome according to the CIWA- Ar (OR -1.59, p= 0.05) and duration of alcohol consumption (OR -1.01, p=0.03) were the risk factors of diabetes type 2 in examined group. Greater BMI was a protective factor against diabetes type 2 in the study group. There was no significant correlation between risk of hypoglycemia and age, BMI, duration of alcohol consumption, alcohol blood concentration on admission, intensity ofwithdrawal syndrome according to the CIWA- Ar scale. A higher frequency of hypoglycemia was found in patients who declared vodka drinking in interview (at the borderline of statistical significance OR - 7.43, p=0.06). CONCLUSIONS: 1. In the study group of alcohol-dependent men, the risk of diabetes was inversely proportional to BMI value. 2. The risk factors of type 2 diabetes in the alcohol-dependent group included the duration of lasting alcohol drinking and the intensity of withdrawal symptoms according to the CIWA- Ar scale. 3. According to the preference of alcohol type, a higher frequency of hypoglycemia was confirmed only in persons preferring to drink vodka.

The effect of acute carbon monoxide poisoning on micronuclei frequency and proliferation in human peripheral blood lymphocytes (case-control study).

OBJECTIVE: Carbon monoxide (CO) exposure is still one of the leading causes of unintentional poisonings. Although its neurological sequels have been extensively studied, the knowledge about cytogenetic conse- quences still remains very limited. The aim of this study was to estimate the genotoxic potential of carbon monoxide in the course of acute poisoning. METHODS: The examined group consisted of 73 patients treated because of accidental acute CO poisoning, and 22 healthy control individuals. Poisoning severity was estimated on the basis of neurological symptoms at admission, age, duration of exposure, carboxyhemoglobin (COHb) level and blood lactate concentration. The cytochalasine-B (cytokinesis blocker) micronucleus assay (CBMN) was used to analyze the cytogenetic alterations in lymphocytes from peripheral blood of the patients. RESULTS: Intoxicated patients displayed higher numbers of micronuclei (MN) than controls. The frequency of MN depended on the age of patients, loss of consciousness, neurological symptoms at admission, and the level of carboxyhemoglobin, but did not correlate with lactate level. We also observed differences in cell responses depending on the gender. CONCLUSION: Our results confirm the presence of cytogenetic changes after carbon monoxide poisoning. Based on these data we conclude, that CO might have genotoxic potential.

[Assessment of alcohol drinking model declared by male citizens living in Kraków district - Podgórze]. / Analiza modelu spozycia alkoholu deklarowana przez mezczyzn mieszkajacych w dzielnicy Krakowa - Podgórzu.

The aim of this paper was the assessment of alcohol model in population of men living in big city. To achieve this target we used data concerning alcohol drinking model incorporated in questionnaire filled by men participants of the Multicentre Studies and Epidemiology of Diabetes conducted from 1998 to 2000, 35-75 years of age, living in the Podgórze district of the city of Kraków. Based on declared data involved drinking frequency and alcohol amount drunk in one sitting in population of 1074 men, 35-75 years of age, we determined that 46.7% participants used to drink more than 2 times weekly and 17.8% drinking alcohol every day or almost every day. Analysis of amount of drunk alcohol in one sitting shown that 81.4% participants use to drink more than 4 standard alcohol units in one sitting and 35% drunk more than 10 standard alcohol units per one sitting. Additionally, in subpopulation of men, 35-50 years of age, so it means at the peak of professional activity period, only 17.76% declared moderate model of alcohol drinking. This study helps to provide proper health services for alcohol addicted persons and induces to active seeking for persons with alcohol drinking problem. It is important not only from improvement of public health point of view but also for social and economic harm reductions followed by alcohol drinking.

[Management of acute intoxication with paracetamol--Polish Medical Society, Section of Clinical Toxicology position statement]. / Postepowanie w ostrych zatruciach paracetamolem--stanowisko Sekcji Toksykologii Klinicznej Polskiego Towarzystwa Lekarskiego.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management in case of suspicion of intoxication with paracetamol.

[Intravenous fat emulsions in toxicology]. / Dozylne emulsje tluszczowe w toksykologii.

Lipid emulsion intravenous infusion is recommended in reversing cardiac toxicity of local anaesthetics. Recent reports indicate, that it may be useful in the treatment of cardiotoxic drug overdose. While the mechanism of action is not fully understood, creation of a "lipid sink" is the predominant effect. The aim of the paper is to present the efficacy and indications for the use of lipid emulsion in acute poisoning, basing on the medical literature.

[Long-term follow-up after intravenous injection of mercury--two cases report]. / Wieloletnia obserwacja po dozylnym wstrzyknieciu rteci metalicznej--opis dwóch przypadków.

In this paper we present the long-term follow-up of two patients, after injection of metallic mercury. Case 1. In 1997, 29-years-old man injected himself to left elbow about 20 ml of metallic mercury by mistake (he was heroin abuser for short time). Mercury concentration in the blood was 400 microg/L. X-ray of the chest, abdomen and affected elbow area showed radiopaque foreign material (depots of mercury). Depots of mercury were also visible on the tricuspid valve in echocardiography. Mercury from the soft tissue left elbow pit was partially surgically removed. During 15 years follow-up two times chelating therapy was performed with d-penicyllamine and DMPS. In 2012, he was admitted to hospital next time. The blood and urine mercury concentration was still elevated (55.2 microg/L and 197 microg/L), mercury depots in the lung and abdomen were present. The signs and symptoms of CNS damage, like peripheral polyneuropathy and ataxia, were diagnosed. CT of brain did not revealed any changes, despite head trauma before 6 years. However neurological findings are typical for chronic mercury poisoning, it is not possible to determine whether these changes are directly related to mercury, because head trauma history, Case 2. In 2003, 16-years-old woman injected herself one month before, in suicidal attempts to both elbows several millilitres of metallic mercury. Mercury concentration in the blood was 56.2 microg/L, in urine 906 microg/L and in the hair 1.12 microg/g. Chest Xray showed depots of mercury in the lung. Mercury from the soft tissue was two times surgically removed. During 9 years two times chelating therapy was performed with d-penicyllamine and DMPS. After 9 years there is no symptoms of mercury poisoning. Mercury depots in the lung are still present. The blood and urine mercury concentration is low (13.7 microg/L and 2.53 microg/L). In mean time she gave birth two healthy children. Further patients evaluation is necessary.

[Severe paracetamol poisoning complicated with liver and renal failure--case report and review of literature]. / Ciezkie zatrucie paracetamolem powiklane ostra niewydolnoscia watroby i nerek--opis przypadku z przegladem literatury.

UNLABELLED: Paracetamol is a widely known over-the-counter analgesic and antipyretic which, in acute poisoning usually causes liver damage, and less commonly damage to the kidney, heart, and pancreas. In the present paper we report a case of acute suicidal paracetamol intoxication complicated by acute hepatic and renal failure. The discussion covers the pathogenesis, clinical course, and treatment of acute renal failure in the course of paracetamol poisoning. CASE REPORT: A thirty-four-year-old woman was admitted to hospital in the second day after ingestion of nearly 17 g of acetaminophen. During admission to the hospital, the maximum values of transaminases (AST 19 350 U/L, ALT 11 760 U/L) were found; they have gradually normalized over the next few weeks. Sequentially monitored serum creatinine showed an upward trend, reaching a value of 588 micromol/L in the fifth day after drug ingestion. The patient underwent 1 haemodiafiltration and 4 haemodialysis treatments resulting in an improvement in renal function. CONCLUSIONS: In acute acetaminophen poisoning, in addition to standard monitoring of liver function, the monitoring of kidney function is necessary because of the risk of acute renal failure due to acute tubular necrosis. Kidney damage is likely to be transient and generally will not need long-term renal replacement therapy.

[Drug-induced erythrodermia complicated by multiorgan failure--case report]. / Polekowa erytrodermia powiklana niewydolnoscia wielonarzadowa--opis przypadku.

Generalized erythroderma or exfoliative dermatitis, is a disease characterized by the appearance of erythematous and scaling skin changes, which often cover greater than 90% of the body's surface. The resulting failure of the skin can coexist with other organ failure and is potentially life threatening. We present a case of a young woman admitted with symptoms of erythrodermia complicated lung and liver failure. The patient's medical history in the first row pointed to the possibility of the coexistence of flu-like infection and drug-induced reactions by antibiotic (makrolide) and nonsteroidal anti-inflammatory drugs (acetaminophen, ibuprofen) therapy two weeks before hospitalization. Rapid progress of the disease and the degree of liver damage found to meet the criteria for liver transplantation for acute liver failure. However, the coexistence of pneumonia and transfusion-related acute lung injury (TRALI) were the reason to postpone transplantation until healing inflammation process and improving lung function. Standard medical therapy was extended by liver albumin dialysis (MARS) with gradual improvement of general state and complete resolution of symptoms. Differential diagnosis was performed and coexistence of other systemic and neoplastic diseases was excluded.

[Sulpiride poisoning--case report confirmed with the quantitative determination of the xenobiotic serum level]. / Zatrucie sulpirydem--opis przypadku potwierdzony ilosciowym oznaczeniem stezenia ksenobiotyku w surowicy.

Despite above 40 years the presence of sulpride on the pharmaceutical market, the acute poisonings are poorly reported in the medical literature. The discussed case of sulpiride intoxication concerns ingestion probably dose of 12 g, that exceeded 10-fold maximum therapeutic dose. 16-year-old girl, with no previous sulpiride treatment, was admitted to the Toxicology Department about 3 hours after ingestion. In clinical picture she presented quantitative consciousness disturbances with maximum 10 scores in GCS scale, with tendency to low BP (minimum 88/45 mmHg) and episode of orthostatic hypotension. The ECG demonstrated: normogram, sinus tachycardia with a heart rate of 125 beats/min, PQ = 120 ms, QRS = 80 ms, prolongation of QTc to 519,6 ms and unspecific changes of ST-T syndrome. The qualitative toxicological test confirmed the presence of chlorprothixene in urine, but the serum therapeutic concentration (0.126 microg/ml) excluded the overdose. The quantitative determination of sulpiride serum concentration confirmed acute sulpiride poisoning. The measured sulpiride toxic concentration on admission and in the consecutive hours were from 13.2 to 8.2 microg/ml. Sulpiride toxicokinetic parameters such as t max = about 3 h, t 1/2 = 24.02 h, k(el) = 0.029 h(-1) were also estimated. They point out that the absorption rate is similar and the elimination is prorogated in sulpiride acute poisoning compared to therapeutic doses.

[The causes and consequences of the cellular death (apoptosis and necrosis) in the course of acute poisoning with carbon monoxide]. / Apoptoza i nekroza--przyczyny i skutki w przebiegu ostrego zatrucia tlenkiem wegla.

The flow cytometry is acquiring more and more clinical importance. Despite its wide application in diagnostics, it is not used commonly in the clinical toxicology. The goal of the current investigation was to evaluate the mechanism for cell death (apoptosis or necrosis) and its manifestation in circulating human lymphocytes exposed to toxic concentration of carbon monoxide (CO). Since the large subpopulation of leukocytes have undergone apoptosis the next step of the studies was to assess the mobilization of progenitor cells (CD 34+) occurring in the peripheral blood after CO intoxication. Data were compared with those of 25 healthy controls comparable in terms of age, gender and physical activity. The application of the method in clinical reasoning was also evaluated. Significantly increased apoptosis of the lymphocytes in research group compared to control individuals correlates with the poisoning severity but does not depend on hypoxia. Decreased number of leukocytes caused by the cytotoxic effect of CO, stimulates the release of the CD 34+ to the peripheral blood. Increased cell death seems to be the relevant mechanism in the pathophysiology of acute carbon monoxide poisoning--the delayed apoptosis as the consequence of the reoxygenation can influence the delayed neurological and cardiological sequelae in patients after acute CO poisoning. In order to improve the treatment and help choose best fitting therapy, there should be need to introduce the new diagnostic methods like flow cytometry or innovative imaging techniques to the standard diagnostics in clinical toxicology.

[Quantitative analysis of heart scintigraphy (99mTc-MIBI GSPECT) with regional myocardial wall motion and systolic thickening of left ventricle assessment for detecting myocardial damage in ethanol withdrawal patients]. / Zastosowanie analizy ilosciowej badania 99mTc-MIBI GSPECT z ocena odcinkowej ruchomosci scian i grubienia skurczowego miesnia lewej komory w aspekcie oceny stopnia uszkodzenia miesnia sercowego w zespole odstawiennym u chorych uzaleznionych od alkoholu--doniesienie wstepne.

Severe ethanol withdrawal syndrome, with psychosomatic symptoms, is life-threatening condition and if not treated can be fatal (in approximately 15% of cases). The purpose of this investigation was to assess cardiac muscle function using 99mTc-MIBI GSPECT in acute alcohol withdrawal. The group examined consisted of 10 males aged from 33 to 45 (45.7 +/- 8.82) because of alcohol withdrawal syndrome. The control group for quantitative analysis of the heart scintigraphy (GSPECT) consisted of 20 people referred for examination to the Laboratory of Nuclear Medicine, Jagiellonian University, which results of cardiac perfusion scintigraphy were assessed as normal. In acute withdrawal syndrome quantitative analysis of the heart scintigraphy (99mTc-MIBI GSPECT) revealed impaired regional wall motion and wall thickening related mainly to the lower wall segments. The abnormalities in myocardial perfusion (99mTc-MIBI GSPECT) was found in varying degrees of severity in all patients.

[The importance and value of the toxicological and biochemical results in the management of the poisoned patient]. / Znaczenie i interpretacja wyników badan toksykologicznych i biochemicznych w postepowaniu z zatrutym pacjentem.

The most important tasks of modern analytic toxicology can be summarized as follows: identification and quantification of toxicants potentially responsible for the intoxication of an emergency patient; confirmation or exclusion of poisoning diagnoses; grading and prognosis of an intoxication; monitoring of elimination therapies; testing for drugs of abuse; exclusion of the presence of central depressants before organ explanation or discontinuation of life support; checking the compliance of patients with prescribed drug therapy; therapeutic drug monitoring. The interpretation of toxicologic results is one of the most difficult tasks in toxicology. It is not always possible to relate symptoms and blood concentrations of drugs and poisons. In many cases, it is necessary to monitor biochemical parameters in the management of poisoned patient.

[Strategic preparedness of selected hospitals to act during massive chemical disasters]. / Strategiczne przygotowanie wybranych szpitali do dzialan w warunkach masowych skaien chemicznych.

The aim of our study was the evaluation of strategic preparedness of twelve hospitals in Kraków, Warsaw and the Triple City to give aid during massive chemical accidents. The study was carried on 146 persons, including 9 managers, 31 ward heads, 75 assistants, and 31 ward nurses. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression has been used. In any of the investigated hospitals, there were no plans regarding of action in case of chemical accidents. The knowledge about sources of possible contamination as well as environment threats were insufficient. The majority of the medical staff did not know their role as well as the role of their hospitals in case of a chemical accident. There is an urgent need for courses about the procedures which should be used during chemical accidents. The lack of hospital preparedness to act during chemical disasters in the big cities suggests that a similar situation is common in other such medical units all over the country. Further investigations, especially in the hospitals which are placed near the potentially dangerous factories, should be carried on in the near future.

[Logistic preparedness of chosen urban agglomeration hospitals to act during massive chemical disasters]. / Logistyczne przygotowanie szpitali w wybranych aglomeracjach miejskich do dzialan w warunkach masowych skaizen chemicznych.

Twelve hospitals--five form Warsaw, three from Kraków, and four from Gdansk and Gdynia were randomized for the study. The logistic preparedness of hospitals during massive chemical accidents has been investigated. There were 146 probands (9 managers, 31 ward heads, 75 assistants and 31 ward nurses) included in the study. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression has been used. No hospital in the three big cities in the country was prepared for any logistic action in case of massive chemical disaster. There were no stationary and mobile decontamination units in the investigated hospitals. There was no individual protective equipment in any of the analyzed hospitals. There were serious deficits in assortment and amount of antidotes which can be used in the treatment of contaminated patients. As much as 97.2% of respondents pointed the poison information centers as a main source of information in case of chemical accidents.

[Essential preparedness of physician to act during massive chemical disasters]. / Merytoryczne przygotowanie lekarzy do dzialan w warunkach masowych skazen chemicznych.

The aim of the study was the evaluation of some aspects of doctors knowledge about the treatment in case of massive chemical accidents. The study was conducted in twelve hospitals in Kraków, Warsaw, and the Triple City. There were 106 doctors (31 ward heads and 75 assistants) included in the study. The questions contained some aspects of: external decontamination, the usage of 0.5% of sodium hypochlorite, the knowledge about the use of selected antidotes and the symptoms of chosen toxidromes. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression was used. The results confirm, that the medical staff is not well prepared to take an effective action in case of a chemical contamination. The essential knowledge of the medical staff in all investigated aspects of chemical safety has been found out to be not satisfactory. There is an urgent need for medical staff to undergo theoretical and practical courses about toxicity of major chemicals. The clinical toxicologists should be asked to prepare up-to-date, advanced methods and regulations for life support in case of heavy chemical accidents.

[The assessment of suicidal risk in the concept of the presuicidal syndrome, and the possibilities it provides for suicide prevention and therapy--review]. / Ocena zagrozenia samobójstwem w koncepcji syndromu presuicydalnego jako perspektywy dla terapii i profilaktyki samobójstw.

OBJECTIVE: To present Erwin Ringel's theory of the presuicidal syndrome as an instrument for the assessment of suicidal risk. METHOD: The literature regarding the presuicidal syndrome was reviewed. RESULTS: As it is evident from the research and works by Ringel, and also from the works by other classics of suicidological literature, such as Farberow, Poldinger, Schneidmann, Beck, and B6hme, the discovery of the presuicidal syndrome has opened up new vistas for the therapy of suicidal tendencies. The knowledge of the nature of the presuicidal syndrome indicates that a specific "anti-suicide" therapy has to be applied. The principal aims of such a therapy include the removal of the patient's feeling of alienation by the creation of a good doctor-patient relationship, the creation of the conditions enabling the patient to vent his/her aggression verbally, the removal of the presuicidal narrowing of the patient's consciousness by the reinforcement of the effective, positive behaviour, and the stimulation of the patient's imagination towards the formulation of new aims in life. CONCLUSION: The concept of the presuicidal syndrome, although somewhat forgotten, still can enhance the understanding of the psychopathology of suicide, contribute to the effective identification of individuals endangered by the occurrence of suicidal tendencies, and contribute to the increase in the effectiveness of the therapy required. Finally, the present authors suggest that the presuicidal syndrome, as a special multifactor psychopathological phenomenon, should be recognized as a diagnostic unit, thus filling in the present gap in the classifications of mental illnesses.

[Committed suicide in the background of the history of previous suicide attempts--a 5-year prospective study of suicide attempts]. / Samobójstwa dokonane na tle historii wystqpujqcych uprzednio prób samobójczych--5-letnie badania prospektywne.

The aim of the study was to estimate the risk factors for eventual suicide in the case of individuals hospitalised for a suicide attempts (or attempted suicide). The group examined comprised 238 patients, who, in the years 2000-2001, were hospitalised in the Department of Clinical Toxicology CM UJ in Kraków for suicidal self-intoxication with medical drugs. The group consisted of 63 males and 175 females ranging in age from 17 to 79 years (the mean age was 36 years). The instruments applied in the examination included a structured interview and a set of psychological tests; complementary information was obtained from the patients' case histories. In the year 2005, on the basis of the data from the Institute of Forensic Medicine in Kraków, it was established that 10 of the patients under consideration--6 females, and 4 males--had eventually committed suicide within the period concerned. The retrospective analysis of the case of each of these 10 individuals revealed that the majority of them had been treated psychiatrically for depression or alcoholic addiction, had experienced parental or marital bereavement, or had experienced serious financial difficulties. The subjects' case histories informed also about the cases of suicidal death in the families of several subjects. As should be pointed out, the results of psychological tests obtained earlier by the 10 subjects concerned did not unequivocally indicated high endangerment by the risk of eventually committing suicide. Finally, it is necessary to observe that alcoholism and depression were the most frequently diagnosed mental disorders in the case of the male suicides. In the case of the female suicides, the results of the analysis reveal a variety of psychological, psychiatric and socio-demographic factors that, eventually, could lead to suicide.